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SHANGHAI - In a major step forward in fighting cervical cancer, a human papilloma virus (HPV) vaccine was made available in China for people under the age of 45 on Thursday.

Cervical cancer is caused by sexually acquired infection with certain types of HPV, with types 16 and 18 causing 70 percent of all cervical cancers. There is also evidence linking HPV with other cancers affecting both male and female genitals.

Cervical cancer is the second most common cancer among women, after breast cancer, with almost 530,000 new cases reported worldwide every year. China has a very high incidence and death rate, with around 98,900 new cases reported in 2015 and 30,500 deaths. In other words, three Chinese women died of cervical cancer every hour.

Qiu Qiong, 35, a mother of two boys, was the first vaccine recipient at the Obstetrics and Gynecology Hospital affiliated to the Fudan University. Her mother died of cervical cancer seven years ago.

"I would never forget my mother"s pain and despair in her last days," said Qiu. "I wanted to get the vaccination immediately."

Men and women can get the HPV vaccination in 287 hospitals in Shanghai. The hospital Qiu visited had received 119 reservations as of 9 am Thursday.

The world"s first HPV vaccine, Gardasil, was developed by US pharmaceutical company Merck and Co, and the China Food and Drug Administration approved it for sale last year. The product is available in many provinces, including Hebei, Shanxi, Hunan and Ningxia Hui autonomous region.

The first HPV vaccine introduced in China was GlaxoSmithKline"s Cervarix, available for anyone aged 9 to 25, which can protect against HPV 16 and 18. Gardasil, which protects against four types of HPV, can be given to people aged 20 to 45. Both vaccines require three shots over six months.

One shot of Gardasil is priced at 803.5 yuan ($127). "It is a little expensive making it cost prohibitive for many poor patients," said Sui Long, chief gynecologist at the Obstetrics and Gynecology Hospital affiliated to Fudan University. "Most cervical cancer patients are on low incomes."

A lack of public awareness is another obstacle. "Only 15 percent of women on the Chinese mainland have heard of the vaccines," said Sui.

Since Gardasil entered the market in 2006, HPV vaccines have become available in more than 130 countries and regions, including Hong Kong, Macao and Taiwan. Due to safety concerns, the vaccines were not available on the Chinese mainland until Cervarix was approved in July 2016.

Mainland residents had to travel to Hong Kong or abroad to get the three-shot vaccination, making the cost higher.

China is also developing its own HPV vaccine, and it is expected to enter the market in 2022.

Gardasil was developed by Chinese cancer researcher Zhou Jian and Australian immunologist Ian Frazer. In 1995, Zhou and Frazer started cooperating with Merck and Co to develop the vaccine. After Zhou"s unexpected death from hepatitis at the age of 42 in 1999, Frazer continued the work until the vaccine was ready for market.

Gong Xiaoming, a leading Chinese gynecologist, has been promoting the HPV vaccination on social media since 2014. He said it is effective and advises all people to get it, the earlier the better, as the virus is primarily transmitted through sexual contact.

Women can also prevent the disease through regular health checks, he said. From 2009 to 2016, China offered free cervical cancer checks to more than 60 million rural women.

"Cervical cancer is potentially fatal but preventable," said Gong. "It"s essential we raise public awareness of the disease and the vaccines."

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